Opinion
NO. 01-17-00088-CV
10-31-2017
NANCY CARMEN CURNEL AND RONALD CURNEL, Appellants v. HOUSTON METHODIST HOSPITAL-WILLOWBROOK AND MICHAEL ESANTSI, Appellees
On Appeal from the 55th District Court Harris County, Texas
Trial Court Case No. 2016-36453
MEMORANDUM OPINION
This is an interlocutory appeal from the trial court's order dismissing healthcare liability claims for failure to serve adequate expert reports. Nancy Curnel presented to the emergency room of Houston Methodist Willowbrook Hospital with elevated liver enzymes caused by a recently prescribed antibiotic. Curnel was examined by several nurses and physicians, including a hospitalist, Dr. Michael Esantsi. While hospitalized, Curnel's liver was biopsied by another physician. During the biopsy, her artery was nicked, causing her severe injuries.
Curnel and her husband, Ronald, asserted healthcare liability claims against Esantsi and Methodist, among others. They served a series of expert reports from a gastroenterologist, Dr. Todd Sheer, and a registered nurse, Julie Fomenko. Sheer and Fomenko opined that Esantsi's and Methodist's failure to consider Curnel's medications as a potential cause of her elevated liver enzymes and other negligent acts and omissions caused her to undergo an unnecessary liver biopsy. Esantsi and Methodist both filed motions to dismiss. The trial court found that the expert reports were deficient as to both Esantsi and Methodist, denied the Curnels' request for an extension to cure the deficiencies, and dismissed the Curnels' claims with prejudice. The Curnels filed a motion for reconsideration, supported by amended expert reports, which the trial court denied as well.
In three issues, the Curnels contend that the trial court abused its discretion by (1) granting Esantsi's and Methodist's motions to dismiss, (2) denying their request for an extension to cure, and (3) denying their motion for reconsideration. We hold that the expert reports were both deficient and incurable. Therefore, we affirm.
Factual Background
The expert reports of Sheer and Fomenko provide the background facts in this case. We accept the expert reports' factual statements for the limited purpose of this appeal.
See Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002) (per curiam) (review of Chapter 74 report is limited to four corners of report).
Curnel is prescribed an antibiotic that can cause elevated liver enzymes
On October 4, 2015, Nancy Curnel presented to a local walk-in clinic, where she was diagnosed with a urinary tract infection and prescribed the antibiotic nitrofurantoin. Nitrofurantoin is known for potential hepatotoxic effects and can cause drug-induced liver injury (DILI).
Curnel presents to the Methodist ER
Four days later, Curnel presented to the Methodist emergency room. Curnel told the nursing staff that she had been sent to the ER by her primary care physician because recent blood work indicated that she had elevated liver enzymes.
An ER nurse took Curnel's medical history. She noted that Curnel was taking several medications for long-standing medical conditions and that none of these medications had caused elevated liver enzymes in the past. She further noted that Curnel had recently been prescribed nitrofurantoin and had been referred to the ER for elevated liver enzymes after having been on the antibiotic for several days. The nurse did not order that Curnel's current medications be evaluated for hepatotoxic potential or otherwise note the possibility that nitrofurantoin might be a potential cause of Curnel's elevated liver enzymes.
After the nurse took Curnel's medical history, Curnel was examined by an emergency medicine physician, Dr. Scott Wiesenborn. Wiesenborn noted that Curnel had recently begun taking nitrofurantoin and had been referred to the ER for elevated liver enzymes. He assessed Curnel's liver and confirmed that her enzymes were elevated. He then tested Curnel for viral hepatitis, and the results were negative. Like the nurse, Wiesenborn did not order that Curnel's current medications be evaluated for hepatotoxic potential or otherwise note that nitrofurantoin might be a potential cause of Curnel's elevated liver enzymes. He diagnosed Curnel with acute hepatitis but did not specify a cause.
Esantsi admits Curnel to the hospital for further testing
Wiesenborn then called the on-duty hospitalist, Dr. Michael Esantsi, to determine whether to admit Curnel for hospitalization. During his examination, Esantsi noted that Curnel had recently begun taking nitrofurantoin, but he did not order that the medication be evaluated for hepatotoxic potential or note it as a potential cause of Curnel's elevated liver enzymes. Instead, he diagnosed Curnel with probable viral hepatitis; admitted her to the hospital; and ordered that she continue taking her current medications, including nitrofurantoin, and undergo a gastroenterology consultation.
Curnel was then examined by a gastroenterologist, Dr. Steven Ugbarugba. During his examination, Ugbarugba did not note that Curnel had been taking nitrofurantoin for the past several days or that Esantsi had ordered that Curnel continue to take the medication as prescribed. Ugbarugba performed a number of tests, which ruled out a number of potential causes of Curnel's elevated liver enzymes. However, like the nurses and physicians before him, Ugbarugba did not evaluate any of Curnel's medications for hepatotoxic potential or note nitrofurantoin as a potential cause of Curnel's elevated liver enzymes.
Curnel continues to take the antibiotic
Over the next two days, Curnel continued to receive nitrofurantoin, and her liver enzymes continued to rise. She underwent further testing, which indicated that she did not have viral hepatitis but was suffering from DILI instead. But the physicians and nursing staff still did not identify nitrofurantoin as the cause of Curnel's elevated liver enzymes. Despite the test results, Esantsi continued to diagnose Curnel with probable viral hepatitis and did not note that her medications were a potential cause of her elevated liver enzymes.
The nitrofurantoin was ordered by Esantsi, dispensed from the hospital pharmacy, and administered by the hospital nursing staff.
In his expert report, Sheer writes, "A CBC [complete blood count] was performed and eosinophilia of 11.8% was noted, indicative of drug induced liver injury."
At the nurses' request, Esantsi ordered that Curnel begin to take acetaminophen, a pain reliever well-known for its hepatotoxic potential.
Other physicians order that Curnel stop taking the antibiotic and undergo a liver biopsy
On October 11, Curnel was examined twice. First, she was examined by Dr. Ugbarugba, who continued to diagnose her with acute hepatitis but noted that the cause of her elevated liver enzymes remained unclear and that she might be suffering from DILI. This was the first time a medical provider had identified DILI as a potential cause of Curnel's elevated liver enzymes. Ugbarugba ordered that Curnel stop taking all hepatotoxic medications; he did not specifically order that she stop taking nitrofurantoin. He also ordered that she undergo a liver biopsy. Second, Curnel was examined by Dr. Yamini Naygandhi, who was covering for Esantsi. Naygandhi ordered a review of Curnel's medications "to find out what [was] causing [her] elevated LFT [liver function tests]." She further ordered that Curnel discontinue nitrofurantoin.
Curnel did not receive nitrofurantoin that afternoon, and her liver enzymes began to improve. The next morning, Curnel's liver enzymes were tested again and showed further improvement. During her liver biopsy , Curnel's artery is nicked
The next day, a radiologist, Dr. Mark Brodie, performed the biopsy of Curnel's liver that was ordered by Ugbarugba. During the biopsy, Curnel's artery was nicked, causing severe injuries. She required multiple blood transfusions, medications to maintain circulation, mechanical ventilation, prolonged resuscitation, and extended ICU care.
Procedural History
The Curnels asserted healthcare liability claims against Esantsi and Methodist. The Curnels served Esantsi and Methodist with a series of expert reports from Sheer and Fomenko. Sheer's reports addressed both Esantsi and Methodist, while Fomenko's addressed only Methodist.
Esantsi and Methodist filed objections and motions to dismiss for failure to serve adequate expert reports. The Curnels responded that the reports were adequate. They requested that the trial court deny the motions to dismiss or, alternatively, grant them a 30-day extension to cure any deficiencies in the reports.
The trial court heard the motions to dismiss and found that the combined expert reports of Sheer and Fomenko were deficient as to both Esantsi and Methodist. The trial court sustained Esantsi's and Methodist's objections, denied the Curnels' request for a 30-day extension to cure, and dismissed the Curnels' claims with prejudice.
The Curnels filed a motion for reconsideration, supported by amended expert reports. The trial court denied the motion, and the Curnels appealed.
The Curnels have filed a motion requesting that they be allowed to exceed the briefing word limit. We grant the Curnels' motion and consider all the briefing they have submitted in reaching our decision.
Motions to Dismiss
In their first issue, the Curnels contend that the trial court abused its discretion in granting Esantsi's and Methodist's motions to dismiss for failure to serve adequate expert reports. The Curnels argue that the trial court's ruling was an abuse of discretion because the expert reports of Sheer and Fomenko represent objective good faith efforts to provide fair summaries of their opinions regarding the alleged negligence of Esantsi and Methodist.
A. Applicable law and standard of review
Under the Medical Liability Act, a plaintiff asserting a healthcare liability claim must timely serve each defendant physician and healthcare provider with a report from a qualified expert. TEX. CIV. PRAC. & REM. CODE § 74.351(a). The expert report must provide a "fair summary" of the expert's opinions regarding the (1) applicable standards of care; (2) manner in which the care rendered by the physician or healthcare provider failed to meet the standards; and (3) causal relationship between that failure and the injury, harm, or damages claimed. Id. § 74.351(r)(6).
The plaintiff may satisfy the requirements by serving reports of separate experts regarding different physicians or healthcare providers or regarding different issues arising from the conduct of a physician or healthcare provider. Id. § 74.351(i). However, only a qualified physician may give opinion testimony about the causal relationship between the claimed injury, harm, or damages and the alleged departure from the applicable standard of care. See id. § 74.351(r)(5)(C).
Although "physician" and "healthcare provider" are separately defined terms, TEX. CIV. PRAC. & REM. CODE § 74.001(a)(12)(A), (23), for ease of reading, throughout the remainder of this memorandum opinion, we will use the term "healthcare provider" to refer collectively to both.
The expert report must represent an "objective good faith effort" to provide a fair summary of the expert's opinions on all three elements. Scoresby v. Santillan, 346 S.W.3d 546, 555-56 (Tex. 2011); see TEX. CIV. PRAC. & REM. CODE § 74.351(l). The expert report must discuss each element with sufficient specificity to inform the healthcare provider of the conduct the plaintiff has called into question and to provide a basis for the trial court to conclude that the claims have merit. Scoresby, 346 S.W.3d at 556; Cornejo v. Hilgers, 446 S.W.3d 113, 120 (Tex. App.—Houston [1st Dist.] 2014, pet. denied).
For standard of care and breach, the expert report must explain what the healthcare provider should have done under the circumstances and what the healthcare provider did instead. Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 880 (Tex. 2001).
For causation, the expert report must explain how and why the healthcare provider's breach proximately caused the plaintiff's injury. Columbia Valley Healthcare Sys., L.P. v. Zamarripa, No. 15-0909, 2017 WL 2492003, at *4 (Tex. June 9, 2017). Proximate cause has two components: (1) cause-in-fact and (2) foreseeability. Id. A healthcare provider's breach was a cause-in-fact of the plaintiff's injury if the breach was a substantial factor in bringing about the harm, and absent the breach (i.e., but for the breach) the harm would not have occurred. Id. A healthcare provider's breach was a foreseeable cause of the plaintiff's injury if a healthcare provider of ordinary intelligence would have anticipated the danger caused by the negligent act or omission. See Price v. Divita, 224 S.W.3d 331, 336 (Tex. App.—Houston [1st Dist.] 2006, pet. denied).
Although the report need not marshal all the plaintiff's proof, it must include the expert's opinion on each of the three main elements: standard of care, breach, and causation. Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010). "No particular words or formality are required, but bare conclusions will not suffice." Scoresby, 346 S.W.3d at 556. Instead, the report must explain the basis of the expert's statements and link the expert's conclusions to the facts of the case. Jelinek, 328 S.W.3d at 539.
If a report includes all the required elements and explains their connection to the defendant's conduct in a non-conclusory fashion, the report is a good faith effort. Samlowski v. Wooten, 332 S.W.3d 404, 410 (Tex. 2011) (plurality op.). But if it omits an element or states the expert's opinions in conclusory form, it is not a good faith effort. Id. In determining whether an expert report constitutes a good faith effort to address each element, "a trial court may not draw inferences; instead, it must exclusively rely upon the information contained within the four corners of the report." Cornejo, 446 S.W.3d at 123.
We review a trial court's ruling on a motion to dismiss a healthcare liability claim for an abuse of discretion. Mangin v. Wendt, 480 S.W.3d 701, 706 (Tex. App.—Houston [1st Dist.] 2015, no pet.). "A trial court abuses its discretion if it acts in an arbitrary or unreasonable manner without reference to any guiding rules or principles." Id.
B. Adequacy of expert report concerning Esantsi
The Curnels supported their claim against Esantsi with expert reports from Sheer. The trial court found that Sheer's reports were deficient on all three elements.
In his reports, Sheer states that the standard of care required Esantsi to evaluate the hepatotoxic potential of Curnel's medications on admission to the hospital, recognize DILI as the probable cause of her elevated liver enzymes, discontinue all hepatotoxic medications, and discharge Curnel and refer her to her primary care provider for outpatient monitoring of her liver enzymes. Sheer further states that Esantsi breached this standard by failing to take any of these steps and instead diagnosing Curnel with probable viral hepatitis rather than DILI, ordering that Curnel continue to take nitrofurantoin (the medication allegedly causing her elevated liver enzymes) and acetaminophen (another hepatotoxic medication), and admitting her for hospitalization and additional unnecessary testing. Sheer then concludes that, had Esantsi considered Curnel's medications as a potential cause of her elevated liver enzymes and discontinued the use of nitrofurantoin and acetaminophen, in reasonable medical probability, Curnel's elevated liver enzymes would have begun to lower, Curnel would have been diagnosed with probable DILI, and she would have been discharged for further outpatient monitoring by her primary care provider—and, as a result, she would not have undergone the liver biopsy that caused her severe injuries.
Assuming without deciding that Sheer's reports adequately addressed standard of care and breach, we hold that the trial court did not abuse its discretion in finding that Sheer's reports were deficient on causation.
First, Sheer's reports do not sufficiently address cause-in-fact. Sheer's reports attempt to show causation by explaining a chain of events that begins with Esantsi's alleged negligence and ends in Curnel's artery being nicked during her liver biopsy. Although it is possible for an expert to show causation in such a manner, in some cases a healthcare provider's negligence may be simply too attenuated from the resulting injuries to the plaintiff to be a substantial factor in bringing about the harm. See Zamarripa, 2017 WL 2492003, at *5 (holding that expert reports failed to explain how hospital proximately caused death of pregnant patient by facilitating her transfer to other facility when treating physician, not hospital, ordered patient's transfer); Providence Health Ctr. v. Dowell, 262 S.W.3d 324, 329-30 (Tex. 2008) (holding that physician's negligence in discharging patient was "too attenuated" from patient's later suicide for proximate cause); Shenoy v. Jean, No. 01-10-01116-CV, 2011 WL 6938538, at *9 (Tex. App.—Houston [1st Dist.] Dec. 29, 2011, pet. denied) (mem. op.) (holding that expert report was deficient on causation because physician's negligence in clearing patient for surgery was "too attenuated" from patient's death from post-surgery complications). This is the case here.
In his reports, Sheer does not opine that Esantsi was negligent in ordering or performing Curnel's liver biopsy; it is undisputed that he did neither. Instead, Sheer opines that Esantsi was negligent in failing to (1) evaluate Curnel's medications, (2) diagnose her with DILI, and (3) discharge her for outpatient monitoring. But the facts from Sheer's own reports indicate that this alleged negligence is too attenuated from Curnel's liver biopsy to be fairly considered a substantial factor in bringing about the harm that resulted from it.
Sheer's reports do not indicate or otherwise demonstrate that Esantsi—who last saw Curnel four days before the biopsy—somehow prevented or discouraged the other physicians from evaluating Curnel's medications and diagnosing her with DILI. To the contrary, Sheer's reports indicate that the physicians eventually did consider DILI as a potential cause of Curnel's elevated enzymes but let the biopsy take place nevertheless.
According to Sheer's reports, after Esantsi examined Curnel on October 8, Curnel was examined by Ugbarugba twice, once on October 8 and once on October 11. When Ugbarugba examined Curnel the first time, he failed to evaluate Curnel's medications for hepatotoxic potential or otherwise note DILI as a potential cause of elevated liver enzymes. And when Ugbarugba examined Curnel the second time, he noted that DILI might be the cause of her elevated liver enzymes and ordered that Curnel stop taking all hepatotoxic medications. But he also ordered that she undergo a liver biopsy. He recognized that Curnel might have DILI but ordered that her liver be biopsied anyway. After Ugbarugba examined Curnel the second time, Curnel was examined by yet another physician, Naygandhi, who expressly ordered that Curnel discontinue nitrofurantoin but did not recommend or order that she not undergo the liver biopsy.
Esantsi's negligence cannot be considered a substantial factor in bringing about the harm. See Zamarripa, 2017 WL 2492003, at *4 (expert report must explain how negligent act or omission was substantial factor in bringing about harm); Cornejo, 446 S.W.3d at 123 (same). Given the numerous different acts by other physicians during the four days between Esantsi's examination and Curnel's biopsy, Esantsi's alleged negligence is too attenuated from the harm. See Zamarripa, 2017 WL 2492003, at *5 (holding that expert reports were deficient because they failed to explain how hospital proximately caused death of pregnant patient); Dowell, 262 S.W.3d at 330 (holding that "the defendants' negligence was too attenuated from the [harm] to have been a substantial factor in bringing it about"); Shenoy, 2011 WL 6938538, at *9; cf. Allways Auto Grp., Ltd. v. Walters, No. 16-0134, 2017 WL 4320712, at *1-2 (Tex. Sept. 29, 2017) (per curiam) (holding that car dealership did not proximately cause collision between intoxicated motorist and other driver by providing loaner vehicle to motorist 18 days before collision occurred, despite fact that motorist was also intoxicated when dealership provided him vehicle).
Second, Sheer's reports do not sufficiently address foreseeability. See Zamarripa, 2017 WL 2492003, at *4-5 (expert report must address foreseeability). Sheer makes no attempt to explain how and why a physician of ordinary intelligence would have anticipated that the other physicians would not evaluate Curnel's medications or that Curnel's artery would be nicked during a liver biopsy performed four days after she was admitted simply because Esantsi initially failed to evaluate Curnel's medications, diagnose her with DILI, and discharge her for outpatient monitoring. Sheer does not attempt to evaluate the risk of a physician negligently performing the biopsy or of Curnel otherwise being injured during the procedure.
We hold that the trial court did not abuse its discretion in finding that Sheer's expert reports did not adequately explain the causal relationship between Esantsi's alleged negligence and the injury claimed by Curnel.
C. Adequacy of expert reports concerning Methodist
The Curnels supported their claim against Methodist with expert reports from Fomenko and Sheer. Fomenko's expert reports address standard of care and breach, while Sheer's address causation. The trial court found that the combined expert reports were deficient on all three elements.
Because Fomenko is a registered nurse and not a physician, she is not qualified to offer an opinion on causation. See TEX. CIV. PRAC. & REM. CODE § 74.351(r)(5)(C).
In her reports, Fomenko states that Methodist breached the standard of care by failing to (1) implement and enforce policies and procedures requiring all hospital and nursing staff to promptly evaluate medications for hepatotoxicity, (2) hold the administration of such medications, and (3) notify attending physicians of their reasons for doing so. Fomenko states that the Methodist nursing staff breached the standard of care by failing to (1) evaluate the hepatotoxic potential of Curnel's medications, (2) recognize that nitrofurantoin is hepatotoxic, and (3) clarify the contraindicated nitrofurantoin order with Esantsi or another practitioner. Fomenko further states that the nursing staff breached the standard of care by administering nitrofurantoin to Curnel for three days in a row.
In his report, Sheer explains that the breaches of Methodist and its nursing staff caused Curnel's injuries by depriving her physicians of "necessary data and information for making the correct diagnosis and considering discharge from the hospital." According to Sheer, had the Methodist nurses complied with the standard of care, the physicians would have had the benefit of the data showing a declining trend in Curnel's liver enzymes, which, in turn, would have led them to diagnose her with DILI and discharge her for further monitoring on an outpatient basis, thereby avoiding the liver biopsy and the injuries that Curnel received from it.
Assuming without deciding that Fomenko's reports adequately addressed standard of care and breach, we hold that the trial court did not abuse its discretion in finding that Sheer's reports were deficient on causation.
First, Sheer's reports do not sufficiently address cause-in-fact. As discussed above, Ugbarugba and Naygandhi both considered DILI as a potential cause of Curnel's elevated liver enzymes, and both ordered that Curnel stop taking all hepatotoxic medications, including nitrofurantoin. On the morning of the biopsy, Curnel's physicians had data showing a recent downward trend in Curnel's liver enzymes. Yet none of her physicians ordered that the biopsy not take place. Even though Curnel's physicians knew that she might be suffering from DILI and had data showing that her liver enzymes had been decreasing since she discontinued nitrofurantoin, none of them objected to the liver biopsy days later. Sheer's reports do not explain how and why additional information from the nurses would have led the physicians to cancel the biopsy if the information the physicians already had did not.
Second, Sheer's reports do not sufficiently address foreseeability. They do not explain how and why a nurse of ordinary intelligence would have anticipated that, as a result of the Methodist nursing staff's failure to evaluate Curnel's medications and notify her physicians of nitrofurantoin's hepatotoxic potential, the physicians would not themselves order that Curnel's medications be evaluated. Nor do they explain how and why such alleged negligence would have led a nurse of ordinary intelligence to anticipate that Curnel's artery would be nicked during a liver biopsy days later.
We hold that the trial court did not abuse its discretion in finding that Sheer's expert reports did not adequately explain the causal relationship between Methodist's alleged negligence and Curnel's injury.
Because the combined expert reports of Sheer and Fomenko failed to adequately address causation for both Esantsi and Methodist, we hold that the trial court did not abuse its discretion in granting both defendants' motions to dismiss. Accordingly, we overrule the Curnels' first issue.
Motion for Extension to Cure
In their second and third issues, the Curnels contend that the trial court abused its discretion by denying their motion for a 30-day extension to cure the deficient expert reports and by denying their motion for reconsideration.
Under the Medical Liability Act, if the plaintiff timely serves an expert report, but the report is somehow deficient, the trial court has the discretion to grant the plaintiff one 30-day extension to cure the deficiencies. TEX. CIV. PRAC. & REM. CODE § 74.351(c). The trial court should err on the side of granting the extension. Samlowski v. Wooten, 332 S.W.3d 404, 416 (Tex. 2011) (Guzman, J., concurring) ("In order to preserve the highest number of meritorious claims, trial courts should err on the side of granting claimants' extensions . . . ."); see also Samlowski, 332 S.W.3d at 411 (plurality op.) (agreeing with concurrence that trial court should err on side of granting extension). And the trial court must grant the extension if the deficiencies are curable. Zamarripa, 2017 WL 2492003, at *5.
We review a trial court's ruling on motion for an extension to cure a deficient expert report for an abuse of discretion. Quintero v. Hous. Methodist Hosp., No. 01-14-00448-CV, 2015 WL 831955, at *2 (Tex. App.—Houston [1st Dist.] Feb. 26, 2015, pet. denied) (mem. op.); Henry v. Kelly, 375 S.W.3d 531, 535 (Tex. App.—Houston [14th Dist.] 2012, pet. denied).
Thirty days after the trial court found the Curnels' expert reports deficient, denied their motion to cure, and dismissed their healthcare liability claims against Esantsi and Methodist, the Curnels filed their motion for reconsideration, which was supported by a fourth amended report from Sheer. The Curnels argue that the amended report shows that the reports found deficient by the trial court were curable, which, in turn, shows that the trial court abused its discretion in denying the Curnels' motion to cure and motion for reconsideration. We disagree.
The motion for reconsideration was also supported by a second amended report from Fomenko. In an attempt to meet their statutory burden, the Curnels served a total of eight expert reports, five of which were from Sheer (Sheer's original expert report and four amended reports) and three of which were from Fomenko (Fomenko's original expert report and two amended reports).
Although Sheer's fourth amended report discusses the facts of the case, standards of care, and manner in which Esantsi and Methodist breached those standards in greater detail, it still fails to adequately address the causal relationship between those breaches and Curnel's injuries. Sheer's fourth amended report offers essentially the same opinions on causation as his previous ones. He still fails to sufficiently address cause-in-fact—he does not show any greater connection between Esantsi's and Methodist's alleged negligence and Curnel's injuries. And he still fails to sufficiently address foreseeability—even though he adds that "there is a risk of cutting one or more blood vessels" during a liver biopsy, he does not explain how and why a physician of ordinary intelligence would have anticipated the risk that one of Curnel's blood vessels would be cut during her biopsy as a result of the alleged negligence of Esantsi and Methodist. Nor does he explain the degree of the risk or the reasonably foreseeable injuries that would occur as a result of cutting a blood vessel.
Because the Curnels have failed to show that their deficient expert reports were curable, we hold that the trial court did not abuse its discretion in denying the Curnels' motion to cure and motion for reconsideration. Accordingly, we overrule the Curnels' second and third issues.
Conclusion
We affirm the trial court's order.
Harvey Brown
Justice Panel consists of Justices Jennings, Bland, and Brown.